L-Glutamate and L-aspartate, the endogenous acidic amino acids, have been firmly established as major excitatory neurotransmitters. The action of these excitatory amino acids is mediated by several distinct receptor subtypes of which the best studied one is the N-methyl-D-aspartate (NMDA) receptor. Excessive activation of the NMDA receptor complex may cause neuronal overstimulation with pathological consequences. Experimental evidence suggests that a prolonged, agonist-evoked conductance of the NMDA-gated ion channel permits an abnormal enhancement of calcium entry, and the resulting increased levels of intracellular calcium play a pivotal, deleterious role in the excitotoxic neuronal damage, neurodegeneration, and delayed neuronal death.
Excitatory amino acids have been implicated in neuropathologies of traumatic, endogenous-genetic, and environmental origin. Brain damage associated with anoxia, hypoglycemia, traumatic injury, stroke, epilepsy, specific metabolic defects, and some chronic neurodegenerative diseases is, to a large extent, produced by excitotoxic mechanisms.
A number of studies have demonstrated that blockade of the NMDA-subclass receptor significantly reduces neuronal damage and loss which occurs in animal models mimicking a variety of neuropathological situations. These observations strongly indicate that NMDA antagonists offer effective neuroprotection in several clinical settings. Thus, agents antagonizing the excitotoxic effects mediated by the NMDA receptor are beneficial in the treatment of ischaemic conditions, stroke, brain or spinal cord injury, and generally, in patients with escalating levels of excitatory neurotransmitters. Specific applications also include therapy of senile dementia Alzheimer-type, parkinsonian dementia complex, Huntington's chorea, and other dominant or recessive spinocerebellar degenerations where NMDA antagonists prevent or retard the progression of the disease.